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12 pages, 538 KB

Open AccessArticle

Funisitis Predicts Poor Respiratory Outcomes in Extremely Preterm Neonates

by Yi-Li Hung, Chung-Min Shen and Wu-Shiun Hsieh

Children 2025, 12(11), 1506; https://doi.org/10.3390/children12111506 - 6 Nov 2025

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Abstract

Background/Objectives: Histological chorioamnionitis (HCAM) is a risk factor of chronic lung disease (CLD) in preterm neonates. Funisitis, an indicator of fetal inflammatory response, has been linked to adverse neonatal outcomes, but its impact on respiratory outcomes in extremely preterm neonates remains uncertain. In [...] Read more.

Background/Objectives: Histological chorioamnionitis (HCAM) is a risk factor of chronic lung disease (CLD) in preterm neonates. Funisitis, an indicator of fetal inflammatory response, has been linked to adverse neonatal outcomes, but its impact on respiratory outcomes in extremely preterm neonates remains uncertain. In this study, we investigated whether HCAM with funisitis is associated with poorer respiratory outcomes when compared with HCAM alone in preterm (gestational age 22–36 weeks) neonates. Methods: This was a retrospective cohort study. We divided very low-birth weight (VLBW) preterm neonates with placenta histopathology examinations into three groups—normal, isolated HCAM, and HCAM with funisitis. Perinatal characteristics, radiographic findings, morbidities, and respiratory outcomes were compared. Results: Among 244 VLBW neonates, 25 (10.2%) had HCAM with funisitis, 88 (36.1%) had isolated HCAM, and the remaining 131 were in the normal group. Neonates with HCAM and funisitis had a significantly lower gestational age (26.44 ± 2.1 weeks) but a higher incidence of clinical chorioamnionitis (40.0%) than those with isolated HCAM (12.5%) or normal placentas (6.9%). Moreover, the incidence of cystic–interstitial lung changes before 2 weeks of postnatal age was higher in the HCAM with funisitis group (56.5%) than in the isolated HCAM group (25.0%), and the normal group (4.4%). CLD occurred in 66.7%, 37.7%, and 1.3% of these groups, respectively, and the need for home oxygen at follow-up was 26.1%, 13.7%, and 6.4%. Both isolated HCAM and HCAM with funisitis protected against severe respiratory distress syndrome. However, extremely preterm birth and funisitis had a more adverse impact on CLD development than HCAM alone (adjusted odds ratio 15.259 vs. 3.841). Conclusions: Funisitis independently predicts poor respiratory outcomes in extremely preterm infants. The long-term clinical impacts of funisitis in preterm infants should be further investigated. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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22 pages, 1295 KB

Open AccessArticle

Machine Learning Models for the Prediction of Preterm Birth at Mid-Gestation Using Individual Characteristics and Biophysical Markers: A Cohort Study

by Antonios Siargkas, Ioannis Tsakiridis, Dimitra Kappou, Apostolos Mamopoulos, Ioannis Papastefanou and Themistoklis Dagklis

Children 2025, 12(11), 1451; https://doi.org/10.3390/children12111451 - 25 Oct 2025

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Abstract

Background/Objectives: Preterm birth (PTB), defined as birth before 37 completed weeks of gestation, is a major global health challenge and a leading cause of neonatal mortality. PTB is broadly classified into spontaneous and medically indicated (iatrogenic), which have distinct etiologies. While prediction is [...] Read more.

Background/Objectives: Preterm birth (PTB), defined as birth before 37 completed weeks of gestation, is a major global health challenge and a leading cause of neonatal mortality. PTB is broadly classified into spontaneous and medically indicated (iatrogenic), which have distinct etiologies. While prediction is key to improving outcomes, there is a lack of models that specifically differentiate between spontaneous and iatrogenic PTB subtypes. This study aimed to develop and validate predictive models for the prediction of spontaneous and iatrogenic PTB at <32, <34, and <37 weeks’ gestation using medical history and readily available second-trimester data. Methods: This was a retrospective cohort study on singleton pregnancies from a single tertiary institution (2012–2025). Predictor variables included maternal characteristics, obstetric history, and second-trimester ultrasound markers. Four algorithms, including multivariable Logistic Regression and three machine learning methods (Random Forest, XGBoost, and a Neural Network), were trained and evaluated on a held-out test set (20% of the data). Model performance was primarily assessed by the Area Under the Curve (AUC). Results: In total, 9805 singleton pregnancies were included. The models performed significantly better for iatrogenic PTB than for spontaneous PTB. For delivery <37 weeks, the highest AUC for iatrogenic PTB was 0.764 (Random Forest), while for spontaneous PTB it was 0.609 (Neural Network). Predictive accuracy improved for earlier gestations; for delivery <32 weeks, the best model for iatrogenic PTB achieved an AUC of 0.862 (Neural Network), and the best model for spontaneous PTB achieved an AUC of 0.749 (Random Forest). Model interpretation revealed that iatrogenic PTB was primarily driven by markers of placental dysfunction, such as estimated fetal weight by ultrasound scan and uterine artery pulsatility index, while spontaneous PTB was most associated with a history of PTB and a short cervical length. Conclusions: Models using routine mid-gestation data demonstrate effective prediction for iatrogenic PTB, with accuracy improving for earlier, more severe cases. In contrast, performance for spontaneous PTB was modest. Traditional Logistic Regression performed comparably to complex machine learning algorithms, highlighting that the clinical value is rooted in the subtype-specific modeling approach rather than in algorithmic complexity. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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10 pages, 222 KB

Open AccessArticle

Acute Peritoneal Dialysis in Critical Preterm Infants: A Case Series and Review of the Literature

by Francesca Riitano, Serena Ferretti, Simonetta Costa, Eloisa Tiberi, Antonio Gatto and Giovanni Vento

Children 2025, 12(9), 1113; https://doi.org/10.3390/children12091113 - 24 Aug 2025

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Abstract

Background: Acute kidney injury (AKI) in critically ill neonates is usually of pre-renal origin and, often, pharmacological treatment is not sufficient for resolution, requiring kidney replacement therapy (KRT). Due to the small body size and the unavailability of adequate devices for these [...] Read more.

Background: Acute kidney injury (AKI) in critically ill neonates is usually of pre-renal origin and, often, pharmacological treatment is not sufficient for resolution, requiring kidney replacement therapy (KRT). Due to the small body size and the unavailability of adequate devices for these patients, peritoneal dialysis (PD) appears to be the most easily achievable procedure. However, guidelines for PD management are lacking in this population. Objective: We aimed to report a single-center experience with preterm infants who underwent PD, describing the technical issues and the outcomes, and to review the existing literature. Methods: This retrospective study included preterm infants undergoing PD because of AKI unresponsive to pharmacological treatment. Data were compared to those available in the current literature. Results: Neonatal outcomes of twelve preterm infants were reported. PD was started before the onset of anuria in two oliguric patients, while it was started within 60 h of anuria in four patients, and between 72 and 144 h of anuria in the remaining six patients. One oliguric patient and one who started PD after 60 h of anuria had a complete recovery of kidney function with normalization of diuresis and renal function parameters. The other infants did not achieve complete resolution of AKI. The mortality rate was 91.7%, and even one of the two infants who had recovered kidney function later died due to an infectious complication. Conclusions: Our experience with a limited sample size did not allow us to obtain definitive conclusions. Our data and the current literature suggested that the prognosis is still negative, with a high mortality rate. Further research is needed to develop guidelines to optimize the management of preterm infants with AKI. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

16 pages, 745 KB

Open AccessArticle

Immature Platelet Fraction as a Sensitive Biomarker in Neonatal Sepsis: Diagnostic Performance Preceding Thrombocytopenia

by Ilkay Er and Medeni Arpa

Children 2025, 12(7), 931; https://doi.org/10.3390/children12070931 - 15 Jul 2025

Cited by 1 | Viewed by 1168

Abstract

Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This [...] Read more.

Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This study aimed to evaluate the diagnostic value of IPF in neonatal sepsis prior to the onset of thrombocytopenia. Methods: This prospective study enrolled neonates with early-onset sepsis (EOS), late-onset sepsis (LOS), and healthy controls. IPF, C-reactive protein (CRP), procalcitonin (PCT), and hematologic indices were measured at diagnosis and 48–72 h post-treatment. Diagnostic performance was evaluated via ROC curve analysis, and correlations between IPF and inflammatory/hematologic markers were examined. IPF levels were also compared based on blood culture results. Results: IPF levels were significantly higher in both EOS (n: 56) and LOS (n: 50) groups compared to controls (n: 44) (p < 0.001). ROC analysis showed excellent diagnostic performance, with AUCs of 0.98 (EOS) and 0.99 (LOS). Following antibiotic treatment, IPF levels declined significantly (p < 0.001), supporting its dynamic value. Strong and moderate correlations were found with MPV and CRP, respectively, and an inverse association with platelet count, but not with PCT. Moreover, IPF levels were higher in culture-positive cases compared to culture-negative ones (13.1% vs. 9.8%; p = 0.017) and exhibited diagnostic performance comparable to CRP in predicting blood culture positivity. Conclusions: This study presents original and clinically relevant data supporting IPF as a promising and practical hematologic biomarker for early detection and treatment monitoring of neonatal sepsis. Its integration into standard sepsis evaluation protocols may improve early risk stratification and clinical decision-making in neonatal intensive care settings. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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12 pages, 756 KB

Open AccessArticle

Continuous Renal Replacement Therapy in Critically-Ill Term and Preterm Newborns: A Single-Center Study in Belgrade

by Snezana Rsovac, Katarina Milosevic, Brankica Spasojevic, Mirjana Cvetkovic, Gordana Milosevski Lomic, Biljana Medjo, Mina G. Cobeljic, Nadja Vukasinovic, Vesna Selakovic, Dusan Todorovic, Masa Petrovic, Davor Plavec and Jasna Kalanj

Children 2025, 12(7), 828; https://doi.org/10.3390/children12070828 - 23 Jun 2025

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Abstract

Background/Objectives: Continuous renal replacement therapy (CRRT) is an important treatment method that is becoming a commonly-used procedure in neonatal intensive care units (NICUs), especially in critically-ill neonates. Methods: We conducted a retrospective study aimed to evaluate factors influencing the outcomes of CRRT in [...] Read more.

Background/Objectives: Continuous renal replacement therapy (CRRT) is an important treatment method that is becoming a commonly-used procedure in neonatal intensive care units (NICUs), especially in critically-ill neonates. Methods: We conducted a retrospective study aimed to evaluate factors influencing the outcomes of CRRT in neonates and preterm infants. The study analyzed data from 41 newborns treated with CRRT at our NICU over a ten-year period. Demographic, clinical, and laboratory parameters were assessed, including gestational age, birth weight, PRISM III score, and laboratory markers like urea, creatinine, and potassium levels, as well as characteristics of CRRT. Results: Our research found that the duration of CRRT, the presence of anuria, and higher potassium levels after initiation of CRRT were significant predictors of a poor outcome. Despite the lack of significant correlation between demographic characteristics, PRISM III score and the outcome, our findings highlight the importance of timely CRRT initiation and efficient management to improve survival. Conclusions: Our study identified several significant prognostic indicators in neonates undergoing renal replacement therapy. While these findings provide valuable insights, further research is needed to establish clear theoretical guidelines and improve clinical decision-making. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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12 pages, 821 KB

Open AccessArticle

The Effect of the COVID-19 Pandemic and the Establishment of a Ronald McDonald House on Skin-to-Skin Times in the Neonatal Intensive Care Unit: A Retrospective Study

by Stephanie Schaible, Edda Hofstätter, Wanda Lauth and Martin Wald

Children 2025, 12(6), 803; https://doi.org/10.3390/children12060803 - 19 Jun 2025

Viewed by 693

Abstract

Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, [...] Read more.

Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, considering factors like the COVID-19 pandemic, the opening of Ronald McDonald House, and sibling presence. Methods: We retrospectively analyzed data from the first eight weeks of life of 93 extremely preterm infants (<28 gestational weeks, <1500 g birth weight) treated at the Salzburg NICU from 2019 to 2023. Skin-to-skin times were recorded to the minute. Results: The mean value skin-to-skin time per visiting day was 241 min (±83), skin-to-skin was performed on 79.0% (±16.8) of the days of stay examined. During the pandemic, skin-to-skin care was performed on 64% of visit days, after the pandemic on 91% (p < 0.001). Before the Ronald McDonald House opened, the skin-to-skin time per visiting day was 215 min (±57.9), afterwards it was 273 min (±97) (p = 0.001). For Primipara the Kangaroo-Care time per day of visit was 257 min (±93), for Multipara 217 min (±52) (p = 0.043). Conclusions: Skin-to-skin is crucial for extremely premature infants and can be implemented for many hours a day. It is an integral part of parent-child interaction in a neonatal intensive care unit. External factors such as infrastructure, pandemic restrictions or siblings have a significant impact on skin-to-skin. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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10 pages, 204 KB

Open AccessArticle

Second Attempt for Patent Ductus Arteriosus (PDA) Closure: Room for Acetaminophen? A Retrospective Single-Center Experience at Gaslini Children’s Hospital

by Samuele Caruggi, Andrea Calandrino, Gaia Cipresso, Marcella Battaglini, Paolo Massirio, Francesco Vinci, Irene Bonato, Chiara Andreato, Federica Mela, Lorenzo Curcio, Alessandro Parodi and Luca Antonio Ramenghi

Children 2025, 12(5), 577; https://doi.org/10.3390/children12050577 - 29 Apr 2025

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Abstract

Background: The diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) occurs in 55% of very low birth weight (VLBW) preterm infants. There is no agreement on the best approach to ensure a quick hsPDA closure. Drug treatment of hsPDA fails in approximately [...] Read more.

Background: The diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) occurs in 55% of very low birth weight (VLBW) preterm infants. There is no agreement on the best approach to ensure a quick hsPDA closure. Drug treatment of hsPDA fails in approximately 20% of cases with an increasing risk of prolonged ventilation, BPD, and NEC, as well as the need for surgical duct ligation. This study aims to highlight the efficacy of ibuprofen versus acetaminophen in the case of a second cycle of medical therapy after the failure of the first pharmacological approach for hsPDA closure. Methods: Every VLBW infant admitted to our NICU and treated for hsPDA was included in our retrospective research. Information about the clinical course, hsPDA diagnosis and treatment, and common complications associated with preterm birth was collected. A comparison was made between patients treated with acetaminophen or ibuprofen to assess effectiveness in hsPDA closing. Results: A total of 286 VLBW infants were included. First-course ibuprofen was effective in 87 of 115 infants (75.7%) treated, acetaminophen in 138 of 171 (80.7%). Second-course therapy with ibuprofen was effective in 62.5% of the patients, while acetaminophen was effective in 69.2%. No statistically significant difference was observed in the first-course and second-course success rates. Conclusions: This study confirms that acetaminophen is not inferior to ibuprofen in the closure of hsPDA in VLBW infants. Our data demonstrate that a second course of medical therapy after the failure of the first course could help close the majority of hsPDA cases without surgery. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

12 pages, 1373 KB

Open AccessArticle

Analysis of Salivary Cytokines in Retinopathy of Prematurity

by Hwa-Shiu Wu, Hsin-Chun Huang and I-Lun Chen

Children 2025, 12(1), 80; https://doi.org/10.3390/children12010080 - 10 Jan 2025

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Abstract

Background/Objectives: This cohort study aimed to establish a correlation between salivary cytokines and retinopathy of prematurity (ROP) in premature neonates. Additionally, we sought to identify a minimally invasive method for cytokine detection in this population. Methods: We recruited premature neonates born at less [...] Read more.

Background/Objectives: This cohort study aimed to establish a correlation between salivary cytokines and retinopathy of prematurity (ROP) in premature neonates. Additionally, we sought to identify a minimally invasive method for cytokine detection in this population. Methods: We recruited premature neonates born at less than 34 weeks gestational age (GA), with no history of maternal or neonatal infections. Salivary samples were collected on their first (D1) and seventh (D7) days of life, and cytokine levels were measured using the MILLPLEXMAP Human multiplex assay. Results: A total of 125 neonates were included in the study, categorized into two groups based on the severity of ROP: None to Mild and Moderate to Severe. The salivary levels of interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF), and tumor necrosis factor (TNF)-α on D1 and D7 were significantly higher in the Moderate to Severe ROP group compared to the None to Mild ROP group (p = 0.005, 0.004, 0.026, 0.018, 0.001, 0.007, 0.025, and 0.002, respectively). After adjusting for GA, the levels of IL-6 and VEGF on D7 were significantly elevated in the Moderate to Severe ROP group compared to the None to Mild ROP group (p = 0.024 and 0.016, respectively). Conclusions: This study establishes a novel, non-invasive method for the early prediction of ROP in premature neonates by correlating salivary cytokine levels in early life with the subsequent development of ROP. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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11 pages, 3317 KB

Open AccessArticle

Reimagining Kangaroo Care for Preterm Infants: A Novel Garment for Safe and Comfortable Bonding

by Alexandra McMillin, Aviva Presser Aiden, Jules P. Sherman, Ruth Ann Crystal and William D. Rhine

Children 2024, 11(11), 1392; https://doi.org/10.3390/children11111392 - 16 Nov 2024

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Abstract

Background/Objectives: Kangaroo Care (KC) has been proven to enhance physiological stability, growth, and bonding in preterm, low-birthweight infants. Despite its benefits, KC is underutilized in Level IV Neonatal Intensive Care Units (NICUs) due to challenges in managing medical equipment. This study introduces the [...] Read more.

Background/Objectives: Kangaroo Care (KC) has been proven to enhance physiological stability, growth, and bonding in preterm, low-birthweight infants. Despite its benefits, KC is underutilized in Level IV Neonatal Intensive Care Units (NICUs) due to challenges in managing medical equipment. This study introduces the Kangarobe™, a novel garment designed to facilitate safe, comfortable, and efficient KC for medically fragile infants in high-acuity NICUs. Methods: From 2021 to 2023, a feasibility study was conducted involving 25 infant-parent dyads in a Level IV NICU. The Kangarobe™ was designed using human-centered design principles and tested on infants dependent on respiratory support. Surveys employing a 5-point Likert scale were administered to parents and nursing staff to assess safety, comfort, ease of use, and procedural access. Results: Survey results showed positive feedback from both parents and nursing staff, particularly in the areas of safety and comfort. For example, 72–80% of parents and nurses responded positively regarding ease and comfort. High level of agreement (76%) on the security of medical line management, with minimal negative feedback. In addition, parents using the Kangarobe™ held their infants for an average of 171 min per session, with a notable increase compared to the typical 75 min, indicating enhanced comfort and feasibility for extended KC sessions. The Kangarobe™ successfully enabled the secure management of medical lines and tubes, with the vertical access window improving procedural efficiency without interrupting KC. Conclusions: The Kangarobe™ demonstrates promise in addressing barriers to KC in high-acuity NICUs. By enhancing safety, comfort, and ease of use, it supports wider adoption of KC practices, potentially improving patient safety, staff efficiency, and family-centered care. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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10 pages, 280 KB

Open AccessArticle

Do Different Amounts of Exogenous Surfactant Differently Influence Cerebrovascular Instability in a Consecutive Group of Preterm Babies? Preliminary Results from a Single-Center Experience

by Andrea Calandrino, Samuele Caruggi, Francesco Vinci, Marcella Battaglini, Paolo Massirio, Gaia Cipresso, Chiara Andreato, Giorgia Brigati, Alessandro Parodi, Giulia Polleri, Diego Minghetti and Luca Antonio Ramenghi

Children 2024, 11(9), 1088; https://doi.org/10.3390/children11091088 - 5 Sep 2024

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Abstract

Background: Thirty years ago, the first attempt by Saliba and colleagues was made to reduce the negative effects (hypercarbia) of exogenous surfactant (ES) by slowing its administration. Sixteen years later, we observed the first less invasive surfactant administration (LISA) attempt by Kribs and [...] Read more.

Background: Thirty years ago, the first attempt by Saliba and colleagues was made to reduce the negative effects (hypercarbia) of exogenous surfactant (ES) by slowing its administration. Sixteen years later, we observed the first less invasive surfactant administration (LISA) attempt by Kribs and colleagues. Many studies, since that time, have tried to minimize the invasiveness of ES and subsequent cerebral blood flow perturbations through studies using near-infrared spectroscopy (NIRS). We sought to address this medical challenge by identifying a less problematic modality of ES administration by delivering multiple aliquots of ES instead of a single one, as typically performed. The aim of this study was to test the hypothesis that a different way of administering ES using more aliquots could be a safe alternative that should be assessed in further studies. Methods: Patients between 26 + 0 and 35 + 6 weeks of gestational age (GA) requiring ES administration were enrolled (April 2023–February 2024). Differently fractioned doses were delivered according to an arbitrary standard dosage (0.3 mL per aliquot in babies < 29 weeks; 0.6 mL in babies ≥ 29 weeks), while NIRS and transcutaneous CO₂ (tCO₂) monitoring were always performed. ES’s effectiveness was assessed based on the reduction in the Oxygen Saturation Index (OSI) after administration. Persistent desaturation, bradycardia, and airway obstruction were defined as adverse effects and used to evaluate safety during ES administration, as well as variability in NIRS-rSO₂ values and tCO₂. Results: Twenty-four patients were enrolled with a median GA of 29 weeks (IQR 4.5) and BW of 1223 ± 560 g. In addition, 50% of the cohort received fewer than three aliquots, whereas the other 50% received more than three. Monitoring was started before the procedure and continued 30′ after the last ES aliquot administration. The variability in NIRS-SpO₂ values was significantly higher in the group (p = 0.007) with a lower number of aliquots administered. Similarly, increased NIRS-rSO₂ values (p = 0.003) and increased tCO₂ levels (p = 0.005) were observed in infants who underwent an ES split after the administration of a low number of aliquots. Conclusions: Our data obtained from the group with > 3 fractionated doses of ES seem to justify the preparation of a more robust study, as the combination of reduced NIRS variability and reduced tCO₂ maximum levels is consistent with more stable cerebral blood flow during the challenging time of ES administration. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

13 pages, 4299 KB

Open AccessArticle

Use of N-Acetylcysteine in Preterm Neonates with Enteral Feeding Intolerance and Intestinal Obstruction: A Case Series and Review of the Literature

by Domenico Umberto De Rose, Francesca Landolfo, Flaminia Pugnaloni, Paola Giliberti, Alessandra Santisi, Claudia Columbo, Ludovica Martini, Maria Paola Ronchetti, Paolo Maria Schingo, Guglielmo Salvatori, Fabio Fusaro, Pietro Bagolan, Andrea Dotta, Irma Capolupo and Andrea Conforti

Children 2024, 11(7), 873; https://doi.org/10.3390/children11070873 - 18 Jul 2024

Cited by 1 | Viewed by 5444

Abstract

(1) Background: The use of N-acetylcysteine (NAC) to relieve meconium obstruction of prematurity in the first days of life has been reported, with NAC reducing the viscosity of luminal contents by cleaving the disulfide bonds of mucoproteins. However, its use in this population [...] Read more.

(1) Background: The use of N-acetylcysteine (NAC) to relieve meconium obstruction of prematurity in the first days of life has been reported, with NAC reducing the viscosity of luminal contents by cleaving the disulfide bonds of mucoproteins. However, its use in this population should be further explored since it has been associated with hypernatremia and transient increase in transaminases and bilirubin. (2) Methods: In this retrospective study, we included neonates admitted because of enteral feeding intolerance and intestinal obstruction from 2019 to 2021 who received NAC as a rescue therapy before explorative laparotomy. (3) Results: We summarized the clinical presentation of six preterm neonates with enteral feeding intolerance and intestinal obstruction who received NAC as a rescue therapy. Four infants (66.7%) gradually improved without the need for explorative laparotomy, whereas two infants (33.3%) underwent the creation of an ileostomy. No cases of hypernatremia or hepatic derangement associated with NAC therapy were observed. (4) Conclusions: We described the use of NAC treatment by nasogastric tube and/or rectal enemas in preterm infants with enteral feeding intolerance and intestinal obstruction after a multidisciplinary assessment, but the limited sample size did not allow us to obtain definitive conclusions and further research is needed in this field, given the limited evidence about NAC treatment in preterm infants. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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9 pages, 995 KB

Open AccessCommunication

Premature Babies Can Be Cared for in the Maternity Ward without an Increased Risk and Discharged with a Feeding Tube If Necessary

by Lea Rösch, Edda Hofstätter, Franziska Krasnitzer-Leitner and Martin Wald

Children 2024, 11(4), 456; https://doi.org/10.3390/children11040456 - 10 Apr 2024

Cited by 2 | Viewed by 2250

Abstract

In general, premature babies are discharged home when they reach full self-feeding. We established a discharge management protocol which allows for discharging late preterm babies with a feeding tube if necessary. This retrospective study included 108 preterm infants (34+ weeks) born in 2019 [...] Read more.

In general, premature babies are discharged home when they reach full self-feeding. We established a discharge management protocol which allows for discharging late preterm babies with a feeding tube if necessary. This retrospective study included 108 preterm infants (34+ weeks) born in 2019 and 2020. The preterm infants discharged with a feeding tube (n = 32) were born at 35.23 weeks’ gestation (±0.884), with a birth weight of 2423 g (±375.1), and were discharged at 7.22 days (±3.63) and had a weight of 3466 g (±591.3) at the first outpatient visit around the expected birth date. The preterm infants discharged without a feeding tube were born at 35.97 weeks’ gestation (±0.702) with a birth weight of 2589 g (±424.84), discharged home at 6.82 days (±7.11) and a weight of 3784 g (±621.8) at the first outpatient visit. The gestational week and birth weight were statistically significantly different between the groups, with a p-value of <0.001 for each, and the length of hospital stay (p = 0.762) and weight at follow-up (p = 0.064) did not significantly differ. No infant required tube-feeding at the time of the first outpatient visit, i.e., the time of expected birth. Therefore, with well-thought-out management, it is possible and safe to discharge preterm infants home with a feeding tube. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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Open AccessCase Report

Neonatal Kaposiform Hemangioendothelioma with Kasabach–Merritt Phenomenon Presenting as Severe Airway Obstruction at Birth: A Case Report

by Soyoung Shin and Ye Jee Shim

Children 2025, 12(11), 1429; https://doi.org/10.3390/children12111429 - 23 Oct 2025

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Abstract

Background/Objectives: Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of infancy, often complicated by Kasabach–Merritt phenomenon (KMP), a consumptive coagulopathy characterized by severe thrombocytopenia and hypofibrinogenemia. Airway involvement at birth is exceptionally rare and can be life-threatening. This study reports [...] Read more.

Background/Objectives: Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of infancy, often complicated by Kasabach–Merritt phenomenon (KMP), a consumptive coagulopathy characterized by severe thrombocytopenia and hypofibrinogenemia. Airway involvement at birth is exceptionally rare and can be life-threatening. This study reports the clinical presentation and treatment course of a full-term male neonate with severe airway obstruction caused by KHE with KMP. Case Presentation: The patient had unremarkable prenatal imaging but presented at birth with severe respiratory distress requiring emergent intubation. Physical examination revealed firm violaceous swelling over the right cervicothoracic region. Laboratory tests showed profound thrombocytopenia (22,000/μL), hypofibrinogenemia (75 mg/dL), and coagulopathy. Imaging findings were consistent with KHE complicated by KMP. Due to bleeding risk, the biopsy was not performed. Initial treatment included platelet and plasma transfusions, intravenous immunoglobulin (IVIG), corticosteroids, and antithrombin III replacement. Vincristine was discontinued owing to gastrointestinal toxicity. Sirolimus therapy was initiated on day 14. Following sirolimus initiation, rapid platelet recovery was observed. At three months, marked tumor regression was documented. After mild recurrence, sirolimus was reintroduced, and the patient remained stable at 16-month follow-up. Conclusions: This case underscores the critical importance of prompt airway stabilization, early recognition of consumptive coagulopathy, and sirolimus-based therapy in managing neonatal KHE with airway involvement. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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